Chest
Clinical InvestigationsHome Care and RehabilitationPrognosis of Severely Hypoxemic Patients Receiving Long-term Oxygen Therapy
Section snippets
Patients
The patients were admitted to three hospitals from 1985 to 1990 with respiratory insufficiency and severe hypoxemia. Most were admitted for an acute exacerbation of airflow obstruction, some with right heart failure. After recovery, they were assessed during several weeks for clinical stability.
According to the Belgian Social Security regulations for reimbursement of LTOT, the patients were selected for oxygen treatment if their PaO2 while breathing air was equal to or lower than 55 mm Hg in a
Results
On an average, the patients were old (mean age, 66 ± 8 years), with severe airway obstruction (FEV1 = 30 ± 12 percent of predicted values) and pulmonary hyperdistention (intrathoracic gas volume [ITGV] = 151 ± 44 percent). The mean transfer coefficient TLCO/VA of the patients able to perform the maneuver was reduced to 57 ± 31 percent of predicted.
The patients were severely hypoxemic with some CO2retention and compensated respiratory acidosis (Table 1). Oxygen breathing drastically improved the
Discussion
The mean PaO2 while breathing air (48 ± mm Hg) of the patients from the present series was lower than that of other LTOT series5, 6, 7,11,17,18,35 where mean PaO2 exceeded 50 mm Hg. Under O2 therapy, our patients and those from the MRC reached, nevertheless, a slightly higher PaO2 than in the other series. As far as PaCO2 is concerned, most studies report, as we do, a moderate hypercapnia,6, 7, 8,11,15,18,19 while others5, 13, 14 show a mean PaCO2 within normal limits. All of the studies
Conclusion
In conclusion, the mortality rate of our severely hypoxemic COPD patients (PaO2 ≤ 55 mm Hg) remained considerably high, in spite of LTOT. According to the Cox model, the best predictors of a poor outcome were the following: a low TLCO/VA, a small ITGV, a severe airflow limitation, the fact that O2 therapy does not increase PaO2 above 65 mm Hg, and, from the clinical point of view, increasing age, and the presence of chest wall abnormalities.
The clinical and functional profile of the patients,
ACKNOWLEDGMENTS
The authors wish to thank their colleagues L. Delaunois, Y. Sibille, and P. Weynants for providing the records of many patients; the technical staff: J. P. Delwiche, F. Wautelet, F. Licope, F. Wanthier, F. Pirson, Cl. Goffin, and J. Duplicy; and M. Laureys for improving the English style of the paper and preparing the typescript.
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revision accepted May 28.